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Principles of Oral Health Management for the HIV/AIDS Patient. A Course of Training for the Oral Health Professional.

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Principles of oral health management for the hiv aids patient

Principles of Oral HealthManagement for the HIV/AIDS Patient

A Course of Training for the Oral Health Professional

Made possible from a grant to the New York State Department of Health AIDS Institute from the HIV/AIDS Bureau, Division of Community Based Programs, Health Resources and Services Administration, DHHS


Module 2 basic principles of management

Module 2Basic Principles Of Management

Stephen N. Abel, DDS, MS

Francisco Ramos-Gomez, DDS, MS, MPH


Basic principles of management
Basic Principles Of Management

  • The principles of good oral health care are the same for people with HIV as they are for all dental patients.

  • There is no evidence to support alterations in oral health care solely based on HIV status.

  • By focusing on routine and preventive care, dentists can maintain and improve the quality of life for patients with HIV.


General treatment planning
General Treatment Planning

  • Oral health can impact upon systemic health; systemic health can impact upon oral health.

  • Modifications of care are similar to other medically compromised patients.

  • Individual needs assessments (fiscal, physical and psychosocial, etc) will ensure more successful treatment outcomes.


General treatment planning1
General Treatment Planning

  • The initial visit should include a completely documented overview of the patient’s overall oral condition along with medical status review.


Restorative considerations
Restorative Considerations

  • Most principles are similar to those of the general population

  • Poor candidates for extensive restoration include those with:

    • rampant caries

    • reduced salivary flow

    • oral acidity

    • dysgusia

    • compromised motor skills upper airway obstruction

    • poorly controlled oral manifestations


Xerostomia
Xerostomia

  • Impacts on hard and soft tissue

  • Impacts on quality of life

  • Treatments are available

    • (prescription and OTC)


Oral surgery treatment planning guidelines
Oral Surgery: Treatment Planning Guidelines

  • Follow same principles as other medically complex patients.

  • Communicate

  • Immune-compromised patients may at some points be more susceptible to infection, bleeding and delayed healing

  • Update the medical history


Oral surgery antibiotic therapy

Oral SurgeryAntibiotic Therapy


Antibiotic pre medication in the absence of infection
Antibiotic Pre-medication In The Absence Of Infection

  • To prevent complications associated with post-procedural bleeding, delayed healing or infections.

    • According to AHA guidelines to prevent SBE

    • Neutropenia

    • Indwelling catheters?



Oral surgery extractions
Oral Surgery: Extractions

  • Post-Operative Complications

    • Dry socket

    • Other


Oral surgery
Oral Surgery

  • Incidence of post-procedural complications is no greater than in other populations


Summary of oral surgery considerations
Summary Of Oral Surgery Considerations

  • Collaborate with other members of primary care team.

  • Routine antibiotic use is contraindicated

  • Hemostatic function assessment is indicated before extensive surgery

  • Aseptic technique reduces post-procedural complications

  • Incidence of complications no higher in HIV+ population


Dental caries
Dental Caries

  • Cariogenic potential of drugs

  • HIV-associated xerostomia

  • Drug associated xerostomia

  • Acid reflux

  • If recurrent caries cannot be controlled, extensive crown and bridge should be avoided



Periodontal considerations
Periodontal Considerations

Linear Gingival ERYTHEMA (LGE)




Periodontal considerations1
Periodontal Considerations

Necrotizing Ulcerative Gingivitis (NUG)


Periodontal considerations2
Periodontal Considerations

Necrotizing Ulcerative Periodontitis (NUP)





Implants
Implants

  • Studies to date have demonstrated no differences in the success rate of implants between HIV+ and HIV- patients


Endodontic considerations
Endodontic Considerations

  • Endodontic treatment appears to offer many benefits and few drawbacks for HIV patients

    • Reduced infection risk

    • Reduced need for extraction

    • Improved ability to chew

    • Improved self-esteem


Endodontic considerations1
Endodontic Considerations

  • Endodontic treatment and post-procedural complications.

  • Consider one-step endodontic therapy when appropriate.


Orthodontic considerations
Orthodontic Considerations

  • Factors to consider before instituting therapy

  • Factors to consider due to non-treatment


Prosthodontic considerations
Prosthodontic Considerations

  • Most principles are similar to the general population.

  • Special considerations should be given to those with:

    • candidiasis

    • xerostomia

    • wasting syndrome

    • slower bone remodeling resulting in more frequent relines



Additional hiv oral health guidelines
Additional HIV Oral Health Guidelines

  • Review any issues surrounding HIV drug adherence

  • Work to teach other members of the primary care team to understand the importance of oral health as a component of comprehensive HIV care.


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